Vegetables, not samosas – Even poor Kenyans are starting to get developed-world diseases
Nov 7th 2015 Economist
Teresa Magesa, who lives in Mukuru, a slum in the south of Nairobi, did not realise for years that she had type 2 diabetes. “I was always feeling that I was carrying a burden,” she says. But despite her frequent headaches and dizziness, diabetes, she thought, was a disease for “fat people”. Only in late middle age did she begin to learn that she needed to manage her blood sugar and eat a more balanced diet.
Historically, non-infectious diseases such as diabetes, cancer or asthma have been more prevalent in the rich world than the poor. But that is changing. Infectious diseases, though still an enormous problem, are on the wane. Across Africa, the mortality rate from malaria has fallen by more than half since 2000. That is a remarkable achievement, but chronic diseases, by contrast, are becoming more common. According to the World Health Organisation, of 16m people below the age of 70 who die each year from such diseases, fully 82% live in the developing world. In Kenya they account for 27% of all premature deaths.
The rise of these diseases in the poor world is the result of growing wealth and urbanisation. Whereas subsistence farmers get lots of exercise and eat whatever they can, urban slum-dwellers can live relatively gluttonous lives. On a Sunday afternoon in Mukuru, elderly ladies fry potato chips and samosas in vats of oil to sell to passers-by. Young men sit smoking cigarettes and drinking changaa moonshine. Healthy options are few and far between.
Health care, meanwhile, has not kept up. Slum-dwellers tend to have access to free antiretrovirals if they are HIV-positive, and they can usually get treatment for diseases like cholera and TB. But chronic diseases are unlikely even to be diagnosed. The International Diabetes Federation, which represents sufferers, reckons there are around 775,000 people with diabetes in Kenya, only a quarter of whom know it. As a result, complications such as blindness, kidney stones and the like are more common than in the West, says Daphne Ngunjiri, the chief medical officer of Access Afya, an NGO that treats Ms Magesa. Diseases such as breast cancer in Africa are typically a death sentence.
That is changing. In October Novartis, a large Swiss pharmaceutical firm, launched a programme selling 15 drugs to low-income patients in Kenya for the treatment of diabetes, breast cancer, respiratory illnesses and heart disease and hypertension. A course costs around a dollar a month. Delivering such drugs requires more sophisticated health-care systems than many poor countries have, admits Harald Nusser, the head of the programme. But the firm reckons there are 30 poor countries where the business could be viable.
In 2008 Uganda, a country of almost 38m people, had just one oncologist who was responsible, in theory, for the treatment of around 10,000 people a year. It now has 12, as well as a cancer-treatment centre in Kampala, the capital. Technology helps, too. A smartphone app used with white vinegar allows a doctor to do a physical inspection of a woman’s cervix remotely without doing a Pap smear; another app allows doctors to monitor heart rhythms without an expensive ECG.
Perhaps best of all, Africans are finding ways to pay for their own health care. In Nairobi even slum-dwellers are members of informal savings clubs that cover unexpected health costs.
The question is whether improvement can keep up with changing lifestyles. Urbanisation, with its many benefits, also means more slum-dwellers living on chips, changaa and cigarettes, and getting less exercise. Still, people like Ms Magesa are learning how to cope with their conditions. That knowledge alone will help. She has six children and grandchildren, she says. And now she knows what diabetes is, she insists that they eat their vegetables.